DEPARTMENT OF INSURANCE

Affiliations

Name	Eversports & Entertainment Insurance Inc	DOIID	807327	NAIC NPN	16924430

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	4/5/2013		3/31/2025
Active	Non Resident	Agent	Health	3/7/2014		3/31/2025
Active	Non Resident	Agent	Casualty	4/5/2013		3/31/2025
Inactive	Non Resident	Agent	Life	3/7/2014	1/3/2020
Active	Non Resident	Surplus Lines Broker	Not Applicable	4/9/2013		3/31/2025
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	01/15/2025	03/31/2025
Surplus Lines Broker	01/15/2025	03/31/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date
Active	AXIS Insurance Company	301290	Agent - Health	8/22/2014
Active	Everest Denali Insurance Company	941054	Agent - Casualty	2/18/2020
Active	Everest Denali Insurance Company	941054	Agent - Property	2/18/2020
Active	Everest National Insurance Company	301319	Agent - Casualty	6/13/2016
Active	Everest National Insurance Company	301319	Agent - Property	6/13/2016
Active	Everest Premier Insurance Company	941053	Agent - Casualty	2/18/2020
Active	Everest Premier Insurance Company	941053	Agent - Property	2/18/2020
Active	United States Fire Insurance Company	582240	Agent - Casualty	1/24/2014
Active	United States Fire Insurance Company	582240	Agent - Property	1/24/2014

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Clausen, Andrea Michele	1028165	Agent - Casualty	4/6/2022
Active	Clausen, Andrea Michele	1028165	Agent - Health	4/6/2022
Active	Clausen, Andrea Michele	1028165	Agent - Property	4/6/2022
Inactive	Harris, David A	364917	Agent - Casualty	4/5/2013	1/3/2020
Inactive	Harris, David A	364917	Agent - Health	3/7/2014	1/3/2020
Inactive	Harris, David A	364917	Agent - Life	3/7/2014	1/3/2020
Inactive	Harris, David A	364917	Agent - Property	4/5/2013	1/3/2020
Inactive	Harris, David A	364917	Surplus Lines Broker - Not Applicable	4/9/2013	1/3/2020
Inactive	Holzinger, Jody Lynn	642575	Agent - Casualty	7/15/2014	1/8/2018
Inactive	Holzinger, Jody Lynn	642575	Agent - Health	4/20/2015	1/8/2018
Denied	Holzinger, Jody Lynn	642575	Agent - Life
Inactive	Holzinger, Jody Lynn	642575	Agent - Property	7/15/2014	1/8/2018
Denied	Landrum, Charles Thomas	563579	Agent - Casualty
Denied	Landrum, Charles Thomas	563579	Agent - Health
Denied	Landrum, Charles Thomas	563579	Agent - Property
Inactive	Landrum, Charles Thomas	563579	Surplus Lines Broker - Not Applicable	7/23/2014	3/22/2021
Active	Nikolai, David	633792	Agent - Casualty	12/18/2018
Denied	Nikolai, David	633792	Agent - Health
Denied	Nikolai, David	633792	Agent - Life
Active	Nikolai, David	633792	Agent - Property	12/18/2018
Active	Nikolai, David	633792	Surplus Lines Broker - Not Applicable	11/15/2019
Inactive	Peters, Marla Krull	632885	Agent - Casualty	5/4/2015	1/7/2016
Inactive	Peters, Marla Krull	632885	Agent - Health		1/7/2016
Inactive	Peters, Marla Krull	632885	Agent - Life		1/7/2016
Inactive	Peters, Marla Krull	632885	Agent - Property	5/4/2015	1/7/2016
Active	Pfefferkorn, Michael A	634062	Agent - Casualty	6/10/2016
Active	Pfefferkorn, Michael A	634062	Agent - Health	3/9/2016
Denied	Pfefferkorn, Michael A	634062	Agent - Life
Active	Pfefferkorn, Michael A	634062	Agent - Property	6/10/2016
Active	Robinson, Charles Lowery	806386	Agent - Casualty	8/4/2014
Active	Robinson, Charles Lowery	806386	Agent - Property	8/4/2014
Inactive	Wachenschwanz, Doreen A	507110	Agent - Casualty	5/14/2018	3/20/2019
Denied	Wachenschwanz, Doreen A	507110	Agent - Health
Inactive	Wachenschwanz, Doreen A	507110	Agent - Property	5/14/2018	3/20/2019